Protocol Decreases Sternal Wound Infections after Cardiac Surgery

No pediatric guidelines currently address reducing sternal wound infections (SWI), a complication of cardiac surgery that increases morbidity, mortality and financial costs. A team of researchers at the University of Texas Health Science Center conducted a 2-year prospective quality improvement project aimed at reducing the incidence of SWI.

The study was the follow-up to an initial nationwide, multi-institutional study carried out by the group in 2009. That first study revealed that programs across the country had no standardized manner in which to prevent SWIs.1 This is in contrast to the adult cardiac surgical population where there are well-described protocols to prevent such infections.

Elements of the protocol included preoperative baths with a skin disinfectant, using single patient use electrodes, attention to timing of preoperative antibiotics (no longer than an hour prior to surgery), and specialized care of the infant with delayed sternal closure.

The study team analyzed 308 children who had sternotomies during the study period and found a 61% reduction in all SWI over the study period; 14 SWI in the first year to 5 SWI in the 2nd year. Children whose sternal closure was delayed had a significantly higher overall risk of SWI; using a protocol for children with delayed sternal closure produced a lower infection rate, though not statistically significant, from 26.9% in the study’s first year to 8.3% in the second year.

These investigators said their findings justify a multicenter study of a protocolized approach to SWI prevention in children.  


  1. Woodward CS, Son M, Calhoon J, Michalek J, Husain SA. Sternal wound infections in pediatric congenital cardiac surgery: a survey of incidence and preventative practice. Ann Thorac Surg 2011;91:799-804.

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